Increasing risk of revision due to infection after primary total hip arthroplasty: results from the Nordic Arthroplasty Register Association

Håvard Dale; Anne Marie Fenstad; Geir Hallan; Søren Overgaard; Alma B Pedersen; Nils P Hailer; Johan Kärrholm; Ola Rolfson; Antti Eskelinen; Keijo T Mäkelä; Ove Furnes

doi:10.2340/17453674.2023.13648

Acta Orthopaedica (Jun 2023)

Increasing risk of revision due to infection after primary total hip arthroplasty: results from the Nordic Arthroplasty Register Association

Håvard Dale,
Anne Marie Fenstad,
Geir Hallan,
Søren Overgaard,
Alma B Pedersen,
Nils P Hailer,
Johan Kärrholm,
Ola Rolfson,
Antti Eskelinen,
Keijo T Mäkelä,
Ove Furnes

Affiliations

Håvard Dale: The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
Anne Marie Fenstad: The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
Geir Hallan: The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
Søren Overgaard: Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark; The Danish Hip Arthroplasty Register, Aarhus, Denmark
Alma B Pedersen: The Danish Hip Arthroplasty Register, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
Nils P Hailer: Section of Orthopaedics, Department of Surgical Sciences, Uppsala University Hospital, Sweden; The Swedish Arthroplasty Register, Gothenburg, Sweden
Johan Kärrholm: The Swedish Arthroplasty Register, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Ola Rolfson: The Swedish Arthroplasty Register, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Antti Eskelinen: Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland; The Finnish Arthroplasty Register, Helsinki, Finland
Keijo T Mäkelä: The Finnish Arthroplasty Register, Helsinki, Finland; Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Finland
Ove Furnes: The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway

DOI: https://doi.org/10.2340/17453674.2023.13648
Journal volume & issue: Vol. 94

Abstract

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Background and purpose: The incidence of periprosthetic joint infection after total hip arthroplasty (THA) may be increasing. We performed time-trend analyses of risk, rates, and timing of revision due to infection after primary THAs in the Nordic countries from the period 2004–2018. Patients and methods: 569,463 primary THAs reported to the Nordic Arthroplasty Register Association from 2004 to 2018 were studied. Absolute risk estimates were calculated by Kaplan–Meier and cumulative incidence function methods, whereas adjusted hazard ratios (aHR) were assessed by Cox regression with the first revision due to infection after primary THA as primary endpoint. In addition, we explored changes in the time span from primary THA to revision due to infection. Results: 5,653 (1.0%) primary THAs were revised due to infection during a median follow-up time of 5.4 (IQR 2.5–8.9) years after surgery. Compared with the period 2004–2008, the aHRs for revision were 1.4 (95% confidence interval [CI] 1.3–1.5) for 2009–2013, and 1.9 (CI 1.7–2.0) for 2014–2018. The absolute 5-year rates of revision due to infection were 0.7% (CI 0.7–0.7), 1.0% (CI 0.9–1.0), and 1.2% (CI 1.2–1.3) for the 3 time periods respectively. We found changes in the time span from primary THA to revision due to infection. Compared with 2004–2008, the aHR for revision within 30 days after THA was 2.5 (CI 2.1–2.9) for 2009–2013, and 3.4 (CI 3.0–3.9) for 2013–2018. The aHR for revision within 31–90 days after THA was 1.5 (CI 1.3–1.9) for 2009–2013, and 2.5 (CI 2.1–3.0) for 2013–2018, compared with 2004–2008. Conclusion: The risk of revision due to infection after primary THA almost doubled, both in absolute cumulative incidence and in relative risk, throughout the period 2004–2018. This increase was mainly due to an increased risk of revision within 90 days of THA. This may reflect a “true” increase (i.e., frailer patients or more use of uncemented implants) and/or an “apparent” increase (i.e., improved diagnostics, changed revision strategy, or completeness of reporting) in incidence of periprosthetic joint infection. It is not possible to disclose such changes in the present study, and this warrants further research.

Published in Acta Orthopaedica

ISSN: 1745-3674 (Print); 1745-3682 (Online)
Publisher: Medical Journals Sweden
Country of publisher: Sweden
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://actaorthop.org/

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